糖尿病预防计划参与者的长度新陈代谢轨迹揭示了微型和宏观血管并发症风险不同的子组
Emily Kobayashi1,2, Nathaniel J Linden-Santangeli3, Nicholas Chan1
1Bioinformatics and Systems Biology Graduate Program, University of California, San Diego, La Jolla, CA.
Diabetes care
|August 26, 2025
概括
糖尿病前期的发展轨迹各不相同,有些人在新陈代谢方面保持健康,而有些人则患上胰岛素耐药性或功能障碍,增加并发症的风险. 早期干预可以预防心血管事件.
科学领域:
- 代谢健康和疾病进展
- 糖尿病研究中的纵向研究
- 临床表型和风险分层
背景情况:
- 2型糖尿病 (T2D) 和其并发症在几十年内发展,对糖尿病前期的早期进展的了解有限.
- 疾病发展的异质性需要确定针对性干预的不同患者子组.
研究的目的:
- 调查从糖尿病前期开始的长期代谢轨迹是否可以识别具有不同T2D并发症风险的子组.
- 分析代谢模式如何影响微血管和宏血管事件的发展.
主要方法:
- 对19年糖尿病预防计划/结果研究中1,732名参与者的临床数据进行分析.
- 使用张量分解来识别纵向模式和高斯混合模型来定义集群.
- 使用Cox和后勤回归量化集群特异性并发症风险.
主要成果:
- 发现了四种不同的代谢.
- 尽管出现T2D,但两组 (73%) 的代谢表现稳定,并发症率低.
- 一个群体 (12%) 呈现出快速的胰岛素耐药性和高血糖症,导致视网膜病变和神经病变的高率.
- 第四个群体 (15%) 呈现出早期的小albuminuria和逐渐下降的功能,使心血管事件的风险增加了一倍.
结论:
- 大多数糖尿病前期患者 (三分之二) 遵循代谢弹性路径.
- 显著的胰岛素耐药性或功能障碍在微血管或宏血管并发症之前出现.
- 在T2D发病之前应对糖尿病前期和小白蛋白尿症患者进行干预,以优化宏观血管事件的预防.
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